MEDICARE: WALGREEN CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	21555100	OH
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3673995	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1497762439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	20145 VAN AKEN BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20145 VAN AKEN BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3618
Country	:	US
Telephone Number	:	216-921-6042
Fax Number	:	216-921-3677

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	VIRGINIA GONZALEZ
Credential	:
Telephone Number	:	217-554-8964

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	09/11/2025

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Directions to “WALGREEN CO ” Practice Location

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